Sen. Richard Burr (R-NC) relied on a recent New England Journal of Medicine study — which found that children in Medicaid had a harder time accessing care than those with private insurance — to advocate for substantial reforms of the public health care infrastructure. “Now, the whole debate that we’re having, does Medicare, does Medicaid as currently constructed work?,” Burr asked during a hearing at the Senate Finance Committee today. “It can’t be something that’s working because all of the information is telling us that it’s not,” he said.

Republicans are proposing to transforming Medicaid into a block grant program and providing states with less federal funds and greater flexibility to cut their rolls and institute other benefit changes. Critics maintain that reforming the program by cutting care would only worsen the access problem. It’s a point former CMS head Bruce Vladeck made in responding to Burr:

VLADECK: Absolutely, Medicaid patients have great difficulty in access to care in some communities more than in others and one can only imagine what would happen to those problems in a block grant situation. That’s why CMS has finally belatedly issued regulations to begin to figure out how to define or enforce the access provisions in the statute.

Watch it:

Massachusetts Gov. Deval Patrick (D) — another witness at the hearing — also argued that his state could not maintain its Medicaid program under the kind of block grant structure Republicans are proposing. “There is about a $23 billion cost to us, in cost shifting, over 10 years. A state with a strong balance sheet like ours cannot absorb that and provide the same level of benefits. So you make a decision, you cut benefits or you cut people,” he said. Watch that exchange:

ThinkProgress filed this report from a campaign event in Columbia, South Carolina

Former Utah Gov. Jon Huntsman (R) joined the list of candidates criticizing former Massachusetts Gov. Mitt Romney’s (R) health care plan Wednesday, using an appearance on Good Morning America and a campaign stop in South Carolina to say Romney lacked credibility in the health care debate.

Romneycare, which Huntsman and other Republicans don’t count as a “free market” solution, has plenty of credibility in Massachusetts. Recent polling shows that 63 percent of Massachusetts residents view Romneycare favorably, and the law has been successful on multiple fronts, most notably reducing the state’s uninsured rate to just 1.9 percent. Comparatively, in Utah, 14 percent of the population remains uninsured despite Huntsman’s so-called “free market” reforms.

Yesterday, Huntsman chose to ignore those facts when he argued that Romney had no credibility on the issue:

HUNTSMAN: The question was, when someone who passed and signed that particular law is talking about free market health care, do they have credibility? Otherwise, governors can do whatever they want to do, whatever the aspirations of the people in their state dictate, they can move in that direction. I think the answer was, he would have little credibility talking about market-based health care plans having signed onto that.

Watch it:

Huntsman, who once flirted with the idea of a mandate himself, is correct that Romney lacks credibility on health care. But it’s because Romney has chosen to change his position and ignore the success of the law he signed, not because he signed a law that isn’t working.

The usually soft-spoken Massachusetts Gov. Deval Patrick (D) took a shot at Republican governors this afternoon, describing the GOP’s claim that states should have greater flexibility to manage their Medicaid programs as “a canard.” Patrick made the comments while testifying before the Senate Finance committee:

PATRICK: I think that the question of flexibility strikes me sometimes, frankly, when I hear some of my colleagues talk about it, as bit of a canard because there is a tremendous amount of flexibility we have been offered and we have utilized under the Obama administration and the Bush administration in our own health care reform.

Watch it:

Almost all Republican governors have sought greater flexibility from the federal government, arguing that local officials are best positioned to develop solutions to escalating health care costs. Republican governors have also endorsed House GOP’s block grant proposal. Under that plan, states would receive a pre-determined block grants that would not keep up with health are costs, and would have greater flexibility to make drastic benefit cuts to the program.

Patrick is suggesting that the federal government already allows states to make substantial changes that help save state dollars without sacrificing benefits. States can implement delivery system reforms, set payment strategies without applying for a federal waiver, eliminate optional services, add or increase cost sharing for some services and do a better job of managing and coordinating chronic care. In fact, under the Affordable Care Act, states can even apply for federal funds to better coordinate services for people with chronic conditions and receive federal support to design new models for serving the very expensive dual eligible population.

Inside Health Policy’s Amy Lotven points out that Michigan Gov. Rick Snyder (R) is the only Republican governor to opt out of a GOP governors’ letter asking the federal government for greater state “flexibility” to make reductions to the Medicaid program and calling for the repeal of the Affordable Care Act. Instead, Snyder has sent off his own letter to Energy and Commerce Chair Fred Upton (R-MI) in which he argues that program efficiencies and grants from the federal government have allowed the state “to spend less general revenue on the program than it did a decade ago, even as enrollment has doubled.” These innovations — including a greater investment in managed care and a grant from the federal government that focuses on dual eligibles — have helped the state maintain its Medicaid services.

Snyde has also instructed the state’s Department of Community Health to implement the measure:

In a separate letter to Upton, Snyder said the state had been able to balance its budget without cutting eligibility, optional services or provider payments. He also referenced the September message on health and wellness.

Since he took office, Snyder has sought to avoid comparisons with other new GOP governors, particularly those in Wisconsin and Ohio who quickly sought to enact controversial limits on public employee collective bargaining rights.

When thousands of protesters were rallying in the Capitol in Madison in February, Snyder pointedly said Michigan “was not” Wisconsin.

Snyder has not called for repeal of the federal health care law and his Department of Community Health is proceeding with its implementation, which includes the establishment of a state-level insurance exchange that would give consumers personal insurance market greater choice and access to coverage.

Implementation of the ACA will actually help Snyder strengthen the Medicaid program. The law provides states with a lot of extra cash, insures more residents and — consequently — allows states to “reduce payments they make to support uncompensated care costs.” The federal government picks up the entire tab of Medicaid expansion until 2016. The government will pay for 95 percent of the expansion in 2017, 94 percent in 2018, and 93 percent in 2019. Beginning in 2020, the federal government will fund 90 percent of the expansion. Significantly, the law will also allow an enhanced match to the 11 states that already cover childless adults below 133 percent of the federal poverty level (the 11 states will begin receiving higher federal matching funds for this population until all states receive 93 percent federal matching rate by 2019). The increases in state spending are very small compared to “increases in coverage and federal revenues and relative to what states would have spent if reform had not been enacted.”

So Snyder is the only Republican governor who is making sense on the Medicaid point. The mainstream GOP line is nonsensical: they’re arguing that they don’t have enough money to sustain their existing programs on one hand, but reject extra ACA dollars on the other. That kind of approach only positions them for making drastic cuts that would impact benefits and enrollment. But then again, they were never interested in public safety net programs in the first place.